Catalyzing cross-sectoral advocacy: Constructing the IMPACT theory for mobilizing arts in mental health policy

Abstract

Introduction

As mental health challenges rise globally, arts engagement offers an evidence-based strategy for promotion and treatment. However, cross-sectoral US policy efforts at this intersection remain limited and largely top-down.

Methods

This study employed constructivist grounded theory to explore conceptions of arts in mental health advocacy among stakeholders actively engaged in cross-sectoral practice — artists, public health practitioners, and municipal leaders. Semi-structured interviews were held with 44 participants that represented each of the three primary sectors and spanned work across national and local initiatives.

Results

The data yielded five theoretical categories: Knowledge Needs, Skill and Tool Needs, Policy Needs, Considerations for Advocacy Engagement, and Strategies for Advocacy. These categories informed the development of the IMPACT Theory, a grounded theory that outlines pathways for mobilizing equitable and effective advocacy. Findings emphasize the need for increased stakeholder preparedness, public awareness, and policy mechanisms that support funding, access, and cross-sectoral integration.

Conclusion

To develop actionable and informed advocacy, efforts should increase advocacy preparedness for invested stakeholders, prioritize the time and energy of advocates, and work to improve public awareness about arts and health. This theory offers a framework for advancing arts in mental health policy and may inform broader interdisciplinary advocacy efforts.

Keywords

arts and health arts in health arts in mental health policy mental health policy cross sectoral policy

Introduction

Given the escalation of mental illness and challenges globally, and the multiple spheres of influence contributing to them, socioecological approaches are urgently needed. Among such approaches, arts engagement has been shown to support both the prevention and promotion of mental health as well as the management and treatment of mental illness.¹ As defined for the context of public health research, arts engagement includes modes and forms of participation including dance/movement, literary arts, media, music, theater/performance, as well as visual arts, craft, and design.² Specifically, engagement in the arts has been linked to reductions in anxiety,³ lower risks of developing depression,⁴ and enhanced social and psychological wellbeing.^5–7 Accordingly, arts engagement has been increasingly recognized as a health behavior,^8–10 concurrent to the development of cross-sectoral policies at the international level.¹⁰ This evidence suggests that mobilizing the arts in mental health efforts may be a strengths-based opportunity that warrants greater consideration and uptake.

While advocacy for the arts in mental health promotion offers a viable solution to scale efforts in the United States (US), there has been systemic and scaled defunding of the arts during the Trump administration and the limited scope of advocacy work has predominately been undertaken by national bodies, such as the National Endowment for the Arts and the National Organization of Arts and Health.^10–12 This national purview has been essential in raising the visibility of arts in mental health, but this momentum has lacked the presence of local efforts driven directly by those who are actively engaging in the work. While a “top down” approach to policy change offers the advantage of steering the system, a “bottom up” approach is also warranted as it provides an avenue to approach local concerns with local perspectives.¹³ Additionally, “bottom up” approaches are most appropriate when the scope of work is broad, which is the case at this intersection of arts and mental health.¹³ As policy development for the arts in mental health spaces progresses, it is essential to engage both advocacy and policy at both local and national levels.

To drive community informed change effectively and equitably at a local level, key stakeholders working at this intersection should be the voices leading the effort. Local collaborators in the Arts for Everybody campaign serve as an example of stakeholders directly engaged at this intersection. The One Nation/One Project’s Arts for Everybody campaign, in collaboration with the National League of Cities, mobilized 18 communities across the US to address a localized public health concern through cross-sectoral collaboration among local artists and arts organizations, public health practitioners and departments, and municipal departments and leaders. Notably, most of the projects addressed mental health either directly or indirectly.¹⁴ Local collaborators from initiatives such as this are primed to advocate for political infrastructure to support the sustainability of their work. However, not only is there a lack of support for advocacy, including training and other resources, but there is currently a gap in the literature as it relates to considering stakeholder perspective in advocacy at this intersection. Addressing this gap and exploring existing conceptions of arts in mental health advocacy amongst artists, public health practitioners, and municipal leadership engaged in arts in mental health practice is an important first step to mobilizing informed advocacy efforts. As such, this study sought to understand, “What are existing conceptions about arts in mental health advocacy among engaged stakeholders?” and “What components constitute effective policy development activities aligned with arts in mental health advocacy?”

Data and methods

This study employed constructivist grounded theory, a qualitative methodology and analysis approach, to systematically generate an inductive theory about arts in mental health policy.^15–17 Informed by constructivism — an interpretive framework that contends that data do not have meaning until interpreted and the interpretations themselves are a result of negotiating agreed upon meaning with community¹⁸ — this form builds on traditional grounded theory, which does not engage in community participation to the same degree.¹⁹ The study was deemed exempt by the University of Florida institutional review board (Protocol #: ET00043660).

Participants

Theoretical sampling, a core component of grounded theory,¹⁷ was utilized to determine the scope of the recruited sample. This process occurs in tandem with data analyses to determine what data were needed to further inform the theoretical categories to reach theoretical saturation.¹⁷ The iterative steps undertaken are detailed in the results section. Recruited participants included arts in mental health practitioners who identified as artists, public health practitioners, or municipal leaders. To meet inclusion criteria, practitioners must have had at least 1 year of experience working as a cross-sectoral collaborator in an arts in mental health space. This timeframe ensured that the participants had enough time to be embedded in this work but also accounted for the recent development of programs at this intersection. For instance, individuals who have engaged in arts in mental health practice but had not formally collaborated with another primary sector (arts, public health, or municipal leadership) other than their own were excluded. Purposive sampling allowed for the intentional selection of participants due to characteristics, experiences, knowledge, or other pertinent criteria that are necessary for the study.²⁰ In this case, purposive sampling also allowed for stakeholders engaged in this relatively nasent cross-sectoral work to be identified and engaged. Participants were recruited from arts in mental health practitioners engaged in One Nation/One Project’s 18-city cohort, individuals associated with California for the Arts, and participants engaged in social emotional arts programs through the Arts & Healing Initiative, reflecting a range of national, state, and program-level perspectives.^14,21,22 A snowball sampling approach was used to recruit beyond the direct members of these organizations.²³

Procedure

Following the identification of potential participants from snowballing across the three organizations, a preliminary participation request email was sent. Those who were interested and met inclusion criteria received an email asking them to complete a participant consent form and to indicate their availability for the Zoom interview. If no response was received, two rounds of follow-up emails were sent.

The study included a 30-to-60-min semi-structured interview, which aligned with constructivist grounded theory as it guides conversation while creating space for dialogic reciprocity.^24,25 The interview guide was developed based on trends elucidated from a recent literature review on public health policies that seek to engage the arts to address mental health in the US (see Appendix A).¹¹ The guide was iteratively adapted after each interview to align with the process of garnering theoretical saturation. Additionally, two leading arts in mental health researchers were consulted to thoroughly assess the appropriateness, comprehensiveness, and relevance of the proposed interview guide questions presented.²⁵ While participants had reviewed a consent form prior to the virtual interview session, at the start of the session participants were reminded of the purpose and protocol of the study as well as their rights as participants. To equitably compensate participants for their time, each participant was offered a $50 digital gift card.

Data analysis

The interview recordings were transcribed, and transcripts were de-identified to ensure confidentiality. Both the primary investigator and a graduate-level research associate with qualitative data analysis experience coded the data via qualitative data analysis softwares including the NVivo Qualitative Data Analysis Software and Taguette. Processes of open coding, selective coding, theoretical coding, and axial coding took place in succession.¹⁷ Constant comparison was employed to develop theoretical categories.¹⁷

Engaging two investigators in the coding process bolstered the confirmability and trustworthiness of the reported findings.^26,27 After theoretical categories reached theoretical saturation, participants were invited for member checking, a form of respondent validation. Eliciting participant perspectives on the final categories ensured a more accurate representation of their perceptions and experiences, and supported the trustworthiness of findings.^26,28 The practice and inclusion of reflexivity statements from both coders (see Appendix B) supported the study’s confirmability. Finally, thick descriptions of the data bolster the transferability of the data analysis and results.

Results

Participants

The sample size ranged from 9 to 17 per group (arts, public health, or municipal leadership).²⁹ Based on occupational titles, among the 44 participants, 17 were classified into the arts category, 14 as public health, and 13 as municipal leadership. Participants identified as Arab, Middle Eastern or North African (n = 1); Asian or Asian American (n = 5); Black or African American (n = 13); Latino/a/x, Hispanic or Spanish Origin (n = 8); Native American or Native Alaskan (n = 1); White or Caucasian (n = 23); and one participant preferred not to answer. Relating to gender identity or identities, 11% identified as gender fluid/queer, non-conforming or non-binary (n = 5); 27% identified as a Man (n = 12); and 66% identified as a Woman (n = 29). The mean age was 41.43, the range was 44 (from 25 to 69), the median was 39.5, and the standard deviation was 11.48. Further, of the 44 participants, 17 participants were part of One Nation/One Project’s Arts for Everybody campaign.

Following the initial sample derived from arts in mental health practitioners engaged in One Nation/One Project’s 18-city cohort arts in health initiative, individuals associated with California for the Arts, and participants engaged in social emotional arts programs through the Arts & Healing Initiative,^14,21,22 snowball sampling was undertaken to advance the theoretical sampling. The scope of how each group was defined broadened through the theoretical sampling process — see Appendix C for the definition iterations and rationale as per theoretical sampling guidelines. Data analysis began when interviews started and commenced after theoretical saturation was achieved.^30,31

A Substantive Grounded Theory: The IMPACT Theory

The relationships among the five theoretical categories and their subcategories is illustrated visually in Figure 1 as the IMPACT Theory.

Figure 1.

IMPACT Theory: Integrating Mental health Policy and the Arts for Cross-sectoral Transformation.

Theoretical categories and subcategories

Five theoretical categories were derived from the data: Knowledge Needs, Skill and Tool Needs, Policy Needs, Considerations for Advocacy Engagement, and Strategies for Advocacy. The below sections, and Table 1

Table 1.

Categories, subcategories, and framing.

Category	Subcategory	Subcategory framing
Knowledge needs	Lack of government and policy knowledge	The notion that a central concern among participants is the dearth in baseline understanding of government and policy. A core facet to this subcategory is that stakeholders need to know how the government works so that they can identify where practical points of entry or advocacy “wins” can be realized.
	Understanding arts in mental health evidence-based data	The need for stakeholders to know both where to find facts to support the intersection of arts and mental health as well as mechanisms by which to understand them.
	Case making	Awareness of what the practice of case making is as well as key strategies for case making.
Skill and tool needs	Instruction and curated resources to mobilize effectively	Relates to the need for tools curated for stakeholders that provide relevant evidence and direction to effectively catalyze advocacy efforts for arts in mental health.
	Effectively communicate with key stakeholders	Centers prioritizing strategic communication strategies to engage with decision makers or people who may be of influence in advancing advocacy or policy. This also includes tools and skills to communicate the scope and impact of work in arts in mental health.
	Effectively engage community	Contextualizes the skills that are currently needed across stakeholder groups to activate members of a relevant community. This form of activation provides an opportunity to advance from individual level to collective forms of advocacy work. Participants described how needed skills connect to intentional interpersonal, outreach, and coalition building skills.
Policy needs	Funding	How the mobilization of money is an overarching priority at this intersection and can be centered in policy through pathways for billing codes, insurance reimbursements, cross-sectoral grants, and expansively defined budgets. With these shifts as a priority, participants echoed that job security and accessibility will be further supported.
	Increase access and health equity	How policy can be leveraged at a systems level for increased access, particularly as it pertains to access to arts engagement by groups of people that may benefit most from mental health support.
	Increase integration of cross-sectoral partnerships	A call for the creation of systems level pathways for forming sustainable partnerships for practitioners across fields or disciplines. More specifically, participants voiced how policies and grants are often geared toward only one sector which creates systems of patchwork when cross-sectoral forms of collaboration do occur.
Considerations for advocacy engagement	Lack of advocacy preparedness	The need to prepare stakeholders across sectors by creating clear, shared language; empowering self-identification as advocates; and catalyzing confidence to engage in advocacy. Many participants noted that one of the biggest barriers is not knowing what they need to know.
	Lack of public awareness about arts and health	Recognition of how the general public is largely unaware of the connections between arts and health. It also considers how this may contribute to the undervaluing of the broader impact of the arts by the public.
	Prioritization of time and energy	Contextualization of the challenges of advocacy when basic needs are unmet.
Strategies for advocacy	Advocacy alignment	The importance of having a shared strategic focus among primary stakeholders — artists, public health practitioners, and municipal leadership — as it pertains to case making and raising awareness about arts in mental health. Participants described the need to tailor pitches depending on the audience while also centering on both narratives and economic arguments.
	Stakeholder engagement and influence	An emphasis on how relationship building with key individuals is central to effective advocacy for this intersection. More specifically, it considers the need to identify the individuals and groups with influence who should be the focus of advocacy efforts, build direct relationships with key stakeholders — including decision-makers and community members — and engage stakeholders through arts-in-mental-health experiences.
	Community-centered approaches	The importance of community voice and grassroots involvement in this cross-sectoral advocacy. As it relates to centering community voice, participants explained that it is both important to directly connect with people you are advocating for and to understand and amplify their needs.
	Creative and collaborative advocacy	The innovation, partnership, and expansive ways of imagining advocacy for this intersection.

, detail cross-cutting categories and subcategories, while distinctions by participant group are articulated in (see Appendix D).

Knowledge needs

This theoretical category is characterized by the diverse needs of artists, public health practitioners, and municipal leadership as it relates to facts, information, and practical understandings of key arts in mental health advocacy domains. Participants across groups recognized that the scope and range of advocacy practice is not common knowledge. One participant noted, “…I think it starts…with people not really knowing the definition of things sometimes and only starting from a place of what they think…so, I think when people hear advocacy, they think of…maybe like a very intense person picketing in front of a police car. And not to say that that’s not amazing, but I think a lot of people are afraid of getting in front of, quote, unquote, people of power, right? Like government or police or doing any type of that work” (P15). As illustrated in Figure 1, participants emphasized that addressing knowledge needs will build capacity toward the theoretical category of Skill and Tool Needs. Extending from this category are three subcategories, as detailed in Table 1, including Lack of Government and Policy Knowledge, Understanding Arts in Mental Health Evidence-based Data, and Case Making.

Skill and tool needs

The category of Skill and Tool Needs considers the necessity of learning mechanisms to mobilize foundational knowledge regarding arts in mental health advocacy to effectively build capacity toward engaging in strategic advocacy efforts. Subcategories for this category include Case Making, Instruction and Curated Resources to Mobilize Effectively, Effectively Communicate with Key Stakeholders, and Effectively Engage Community. The subcategory of Case Making is an extension of the subcategory discussed within the category of Knowledge Needs, however, in this context, it extends to the action itself and not just its core components. Relating to Instruction and Curated Resources to Mobilize Effectively, participants noted, “I think tools, great trainings…can be something very beneficial” (P38). Others were more specific as it pertained to needing curated resources that attend to shaping policy; “As somebody who is really interested in… seeing change happen in this current sociopolitical moment, but sometimes doesn’t totally know how to do it, or like where to start, you know, like how to be a good advocate. As somebody who… has the desire to affect policy through her work… What is even best practice for policy advocacy? Because I don’t know if that’s something that I really know a whole lot about” (P36). The additional subcategories for this category are expanded on in further detail in Table 1.

Policy needs

The category of Policy Needs is characterized by needs identified across stakeholder groups that could be directly supported by the institution of policy. Across groups, participants emphasized the need for agreed upon consensus relative to need prioritization in order to to effectively realize policy needs at this intersection. One participant noted that it is imperative to have “coordinated communication and then a clear consensus on the asks of different sectors or different fields” (P29). The subcategories which further contextualize this category include Funding, Increasing Access and Health Equity, and Increasing the Integration of Cross-sectoral Partnerships. Across interviews, participants echoed that job security and accessibility should be further supported for this intersection. Regarding insurance and billing codes, one participant described, “the expansion of current kind[s] of billing codes or service models to include those kinds of interventions that are really focused on social isolation and loneliness” (P18).

Considerations for advocacy engagement

The category of Considerations for Advocacy Engagement positions needed attention across sectors toward garnering public awareness and valuing of arts in mental health alongside the mobilization of advocacy preparedness. Participants expressed the urgency and partnerships needed in this work; “What do we need, right? So, we need people that are committed to the work…We need lots of advocacy. We need people who are on the side of policy making to push for that integration” (P10). Subcategories include Lack of Advocacy Preparedness, Lack of Public Awareness about Arts and Health, and Prioritization of Time and Energy. Many participants noted that one of the biggest barriers is not knowing what they need to know. One participant explained how this also translates into confidence; “barriers could be not knowing enough to feel confident and formulating an informed perspective. So maybe [people need] access to the information [they] would need to feel confident” (P41).

Strategies for advocacy

The category of Strategies for Advocacy emphasizes the importance leaning into strengths-based approaches while tailoring advocacy to political contexts, building meaningful relationships, amplifying community voices, and leveraging innovative and cross-sector methods to drive impactful change. The subcategories for this category include Advocacy Alignment, Stakeholder Engagement and Influence, Community-centered Approaches, and Creative and Collaborative Advocacy. Relating to understanding who to advocate to, participants described that “in terms of amplification…if there are people in powers that are gonna help, I think it’s both like amplifying the voices in those conversations and really just giving space for representation” (P26). Participants also noted that relationships are key before making asks of either decision makers or community members. They also reiterated that experiencing arts in mental health engagement is key to having a greater appreciation for this work; “it’s not shadowing necessarily… It’s like a complete experiential fact check… I think it makes something click. When they can feel secondhand what the artist might feel, or the practitioner might feel. That seems to make a big difference” (P19).

Member checking

Member checking, a voluntary form of respondent validation, enhanced the credibility of this substantive grounded theory by ensuring accurate representation of participants’ perspectives. Seven participants (16.6%) provided written feedback on the first iteration (see Appendix E), prompting revisions. While categories remained unchanged, language within subcategories was clarified. Additions differentiated ideas previously underrepresented. Iterations of the IMPACT theory before and after member checking appear in Appendix F

Discussion

As arts engagement strategies gain momentum internationally as viable and effective methods to support prevention and rehabilitation in mental health, there remains a need in the US to consider how cross-sectoral advocacy for this intersection can be catalyzed intentionally and equitably. As such, this study utilized grounded theory to derive a novel substantive grounded theory and to answer two primary research questions: “What are existing conceptions about arts in mental health advocacy among engaged stakeholders?” and “What components constitute effective policy development activities aligned with arts in mental health advocacy?” The resulting grounded theory articulates that to advance advocacy at the intersection of arts and mental health, it is essential to first address persistent knowledge gaps among invested stakeholders — including artists, public health practitioners, and municipal leaders. Effective policy and advocacy for this intersection must prioritize increased access, funding, and cross-sectoral collaboration, while also enhancing advocate preparedness and public awareness. Finally, community-centered strategies that integrate creative practices and align invested sectors are critical to engaging decision-makers and driving sustainable change.

Invested stakeholders including artists, public health practitioners, and municipal leaders recognize that knowledge gaps persist, which must be addressed before effective skill-building and strategic advocacy can take place. This finding was evident across the categories of Knowledge Needs as well as Skill and Tool Needs. It was further contextualized by subcategories of Case Making, Lack of Government & Policy Knowledge, Understanding Arts in Mental Health Evidence-based Data, and Instruction and Curated Resources to Mobilize Effectively. These evident knowledge, skill, and tool needs align with the Resource Mobilization Theory as intangible and tangible resources shared across existing groups can mobilize social action.³² While these needs have not been previously articulated in the literature for this intersectional space, they align with recent efforts from the field of arts in health to create and mobilize accessible forms of training and data. For example, ACCESS: Arts & Culture for Community health Education and Skill-building Series, a series of courses created through a partnership between Rutgers University and the New Jersey Performing Arts Center,³³ seeks to directly support the subcategory of Instruction and Curated Resources to Mobilize Effectively. It offers low-cost courses as a mechanism by which people can gain relative expertise about key concepts from the field without having to pursue a formal academic degree. Additionally, the formation and expansion of the World Health Organization affiliated Jameel Arts and Health Lab has also begun to support the subcategory of Case Making through its development of plain language policy briefs across arts and health topics.³⁴ National initiatives like the Arts for EveryBody Campaign similarly created plain language reports to accompany each of their peer reviewed publications.¹⁴ Despite these expansions addressing some of the pertinent knowledge needs, accessible skill and tool building needs remain.

Across groups, participants identified central needs for the intersection as it pertains to policy including increasing access, funding, and integrating cross-sectoral partnerships. This finding was substantiated by the category of Policy Needs and the subcategories of Increasing Access and Health Equity, Funding, and Increasing the Integration of Cross-sectoral Partnerships. Relating to the need for access and equity, participants emphasized how policy can act as a lever for increasing access to arts engagement for people that may benefit most from mental health support. According to an epidemiological comparison of types of engagement using data from the US General Social Survey, there is a social gradient in attendance at arts events; for instance, Black participants had 34% lower odds (95% CI = 0.55–0.78) of attendance than White participants.³⁵ Given the benefits of arts engagement for mental health, intentionally derived policies would have the potential opportunity to support mental health equity. This stance could further be supported by the expansion of licensure for creative art therapists across all US states, territories, and commonwealths. The subcategory of funding highlighted the prioritization of establishing mechanisms for billing codes, insurance reimbursements, cross-sectoral grants, and expansively defined budgets. As detailed in a recent review of arts in mental health policy in the US, the discussion of coverage, reimbursement, and incentivization of arts in mental health practices has been discussed in policy guiding documents from national bodies including the Office of Disease Prevention and Health Promotion and the National Assembly of State Arts Agencies.¹¹ Additionally, the WHO report, focused on realizing the potential of the arts to support health and well-being in the US, noted that during a roundtable of national leaders in this space, “participants also emphasized the need to leverage other existing funding pathways and to make government funding more approachable” including the development of arts related sections for priority health areas in public health and funding plans.³⁶ The subcategory of Increasing the Integration of Cross-sectoral Partnerships is well articulated by how participants framed the need for infrastructure and not patchwork. This also aligns with the WHO report which includes a call to action to increase pathways for inter-sectoral collaboration at the federal, state, and municipal levels.³⁶

Advocacy considerations should focus on increasing advocacy preparedness for invested stakeholders, prioritizing the time and energy of advocates, and improving public awareness about arts and health. As it pertains to advocacy preparedness, participants reiterated the need for clear shared language for the intersection of arts and health, and more specifically arts in mental health. While definitions of key terms and some specific policy briefs for the field have been recently developed,^2,34,37 the degree of advocacy mobilization for this intersectional space lacks in comparison to national efforts for the arts from Americans for the Arts or mental health from the National Alliance of Mental Illness.^38,39 Additionally, the perceived need to improve public awareness about arts and health has been reiterated in the literature, and countries like Australia have mobilized a national health promotion media campaign to promote mental wellbeing through the arts.⁴⁰ This relative nascency of public awareness and the intention to garner greater awareness connects to the Diffusion of Innovations Theory which notes how, why, and at what rate a new idea may spread.⁴¹ With this theory in mind, participants in the study would have likened the degree of public awareness to that of only early innovators and some early adopters. To address this, US national leadership have recommended bridging this gap by launching a national communications campaign or proposing “a call to action for the integration of the arts in addressing the epidemic of loneliness and social isolation from the US Surgeon General.”³⁶

Strategies for advocacy at the intersection of arts in mental health need community centered approaches, creative practices, prioritized alignment across invested sectors, and direct engagement of decision-makers. The emphasis on community centered approaches and creative solution based practices from the data reflect the need to prioritize strengths based approaches, and it is also informed by international efforts to mobilize arts and health policy.¹⁰ Further, the notion of increasing advocacy alignment across all invested stakeholders is also informed by Resource Mobilization Theory as when different groups incorporate the same, or similar, resources into their practices they begin to move toward community emergence.³² Participants also highlighted the need in this US sociopolitical moment to focus on local, regional, or institutional policy advancements rather that focusing on the national level. Participants also emphasized the need for this aligned advocacy to uplift both narratives and economic arguments while ensuring tailored framings depending on the audience. This form of framing and advocacy alignment to directed groups is also informed by the concept of agenda setting from the Agenda-Setting Theory,⁴² and the construct of degree of consensus from the Advocacy Coalition Framework also aligns and further affirms this strategy.^43,44

Strengths and limitations

Across this study, there were several strengths and limitations. A notable strength of this work was the inclusion of multiple stakeholder groups, the sample size, and the constructivist approach as together this strategy allowed for depth and breadth of lived experiences in the development of the substantive theory presented. Further, multiple dimensions of trustworthiness were well supported by the methodology employed. More specifically, confirmability was substantiated by the engagement of two coders in the data analysis phase. Member checking was used as a means of respondent validation which supported the credibility of the final theory. Reflexivity statements from both coders further supported the confirmability of the work. Of note is that while categories defined each participant’s primary occupation or affiliation, secondary identities were not documented and could have provided further insight and context. While this study establishes transferability through its use of thick descriptions, it is limited in its generalizability to other populations or contexts. Another limitation is that while constructivist grounded theory approaches intentionally center the researcher’s perspective in shaping knowledge, forms of researcher bias may influence the findings.

Future work and policy considerations

Future work and policies examining arts in mental health policy should seek to continue to amplify the cross-sectoral voices made visible by this work. Researchers may consider how this theory may be applied or revised in other countries or in an international context. There are also opportunities to build this substantive grounded theory into a formal grounded theory which may be of use across a broader scope of interdisciplinary advocacy. Follow-up quantitative analyses may provide insight into which parts of the theory to prioritize energy and resources toward. This theory also echoes a need for accessible knowledge and skill-building resources to effectively mobilize cross-sectoral advocacy for arts in mental health. As established by theorical subcategories, policy needs for this intersectional work should focus on the development of how policies can increase access and health equity, the integration of cross-sectoral partnerships, and create practical funding mechanisms for interdisciplinary work. In action, this theory has the potential to catalyze strategic and equitable advocacy for arts in mental health in the US.

Conclusion

As policy continues to mobilize for arts in mental health internationally, attention should be given to mobilizing equitable advocacy that centers community voice. This study considers how invested stakeholders in the US conceptualize advocacy and policy at this intersection as viable catalysts for the field. Key findings substantiated that artists, public health practitioners, and municipal leaders recognize knowledge and skill gaps that need to be bolstered to enable effective advocacy efforts, and that policy development should center on increasing access, funding, and integrating cross-sectoral partnerships. To develop actionable and informed advocacy, efforts should increase advocacy preparedness for invested stakeholders, prioritize the time and energy of advocates, and work to improve public awareness about arts and health. Strategic advocacy for this intersection should also remain community centered, creative, and prioritize alignment across invested sectors and the direct engagement of decision-makers. The grounded theory developed in this study has the potential to catalyze and support arts in mental health policy work and may offer guidance to advocacy efforts for other forms of cross-sectoral work.

Supplemental Material

Supplemental Material - Catalyzing cross-sectoral advocacy: Constructing the IMPACT theory for mobilizing arts in mental health policy

Supplemental Material for Catalyzing cross-sectoral advocacy: Constructing the IMPACT theory for mobilizing arts in mental health policy by Alexandra K. Rodriguez, Jennifer L. Kuo, George Hack, and Jill Sonke in Community Health Equity Research & Policy

Footnotes

Acknowledgements

The authors would like to thank the Robert Wood Johnson Foundation’s Health Policy Research Scholars Program and the University of Florida College of Public Health and Health Professions for providing funding to support participant compensation for this study. The authors also thank the participants who contributed insight to this theory as this study would not have been possible without them.

ORCID iDs

Alexandra K. Rodriguez

Jennifer L. Kuo

George Hack

Ethical considerations

The University of Florida IRB gave ethical approval for this work; IRB Protocol ET00043660.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Participants were compensated by funding from the Robert Wood Johnson Foundation (Health Policy Research Scholars) and the University of Florida College of Public Health and Professions.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

Direct quotes are provided in the supplemental materials and the full dataset is available upon request.*

Supplemental Material

Supplemental material for this article is available online.

Author Biographies

Alexandra K. Rodriguez, PhD, MPH, mobilizes evidence on the preventive and rehabilitative impacts of arts engagement on mental health into practices and policies that create equitable infrastructure for communities to thrive. She is also a Robert Wood Johnson Foundation Health Policy Research Scholar whose work through the University of Florida Center for Arts in Medicine has contributed to national and international research on arts and health, including arts engagement as a health behavior, defining arts participation for public health, and co-authoring a WHO report on arts and health in the United States.

Jennifer Kuo, MPH, CHES®, is an arts and public health professional whose work focuses on advancing cross-sector collaborations that integrate the arts into public health, mental health, and community well-being. Through education, advocacy, and strategic partnerships, she develops initiatives and resources that bridge research, policy, and practice to expand the role of the arts in health systems and population health.

George Hack, PhD, is the Associate Dean for Educational Affairs in the University of Florida College of Public Health and Health Professions, where he provides leadership for undergraduate, graduate, and professional academic programs. His research focuses on teaching and learning, with particular interests in pedagogical approaches, blended learning, and the interactions among educational technologies, teaching methods, and student characteristics that influence learning outcomes.

Jill Sonke, PhD, is a US Cultural Policy Fellow with Stanford University, serving at the Federal Reserve Bank of New York. She is Co-director of the EpiArts Lab, an NEA Research Lab, Director of Research Initiatives and Research Professor in the University of Florida Center for Arts in Medicine, and an Affiliated Researcher in the Jameel Arts & Health Lab.

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